System to dynamically adjust request values at a back-end application server

ABSTRACT

According to some embodiments, systems, methods, apparatus, computer program code and means may receive data streams from remote third-party administrator computer servers. A back-end application computer server may receive a set of requests from a first third-party administrator computer server, each request being associated with a request value. The back-end application server may retrieve a first set of pre-determined rules and automatically apply them to the set of requests, resulting in an adjusted request value and an overall value. The back-end computer server may then automatically transmit a settlement instruction, including the overall value, to an electronic transaction system, and render a transaction activity report display via a remote computer device, associated with the first third-party administrator computer server, including information about the set of requests, the adjusted request value along with an indication of a reason for the adjustment, and the overall value.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a continuation of U.S. patent applicationSer. No. 14/874,087 entitled “SYSTEM TO DYNAMICALLY ADJUST REQUESTVALUES AT A BACK-END APPLICATION SERVER” and filed on Oct. 2, 2015. Theentire content of that application is incorporated herein by reference.

FIELD

The present invention relates to computer system servers and moreparticularly to computer systems that facilitate a dynamic, accurate,and transparent adjustment of request values at a back-end applicationserver.

BACKGROUND

In some cases, a back-end application platform may receive a set ofmanually generated and/or paper (or pdf file) requests, each requestincluding a request value. For example, the sets of requests may bereceived from different remote third-party administrator platformsthroughout a month. Experts at the back-end application platform mayreview the requests to ensure that each request (and request value)conforms to one of a number of different rules. The experts may changethe request values as appropriate in view of those rules and determinean overall amount associated with each third-party administratorplatform. Reviewing the sets of requests, however, can be a timeconsuming and error prone process—especially when there are asubstantial number of requests, a substantial number of third-partyadministrator platforms, and/or wide ranging differences between therules that need to be used to review the requests. Note that someback-end application platforms might receive sets of requests from tens,or even hundreds, of different third-party administrator platforms (andeach platform could be submitting tens of thousands of requests everymonth).

It would therefore be desirable to provide systems and methods tofacilitate a dynamic, accurate, and transparent adjustment of requestvalues for a back-end application.

SUMMARY

According to some embodiments, systems, methods, apparatus, computerprogram code and means may receive data streams from remote third-partyadministrator computer servers. A back-end application computer servermay receive a set of requests from a first third-party administratorcomputer server, each request being associated with a request value. Theback-end application server may retrieve a first set of pre-determinedrules and automatically apply them to the set of requests, resulting inan adjusted request value and an overall value. The back-end computerserver may then automatically transmit a settlement instruction,including the overall value, to an electronic transaction system, andrender a transaction activity report display via a remote computerdevice, associated with the first third-party administrator computerserver, including information about the set of requests, the adjustedrequest value along with an indication of a reason for the adjustment,and the overall value.

Some embodiments comprise: means for receiving at a communication port aplurality of data streams of electronic messages, each data stream beingreceived from one of a plurality of remote third-party administratorcomputer servers via a distributed communication network; means forstoring information received in the data streams of electronic messagesinto a data stream computer store; means for accessing a rules computerstore storing different sets of pre-determined rules for differentthird-party administrator computer servers; means for receiving, by aback-end application computer server from the data stream computerstore, information associated with a set of requests from a firstthird-party administrator computer server, each request being associatedwith a request value; means for retrieving, by the back-end applicationcomputer server from the rules computer store, a first set ofpre-determined rules for the first third-party administrator computerserver; means for automatically applying, by the back-end applicationcomputer server, the first set of pre-determined rules to the set ofrequests from the first third-party administrator computer server, saidapplication resulting in at least one adjusted request value for the setof requests and an overall value based at least in part on the requestvalues and the adjusted request value associated with the set ofrequests; means for automatically transmitting, by the back-endapplication computer server, a settlement instruction, including theoverall value, to an electronic transaction system; and means forrendering, by the back-end application computer server, a transactionactivity report display via a remote computer device, associated withthe first third-party administrator computer server, includinginformation about the set of requests, the at least one adjusted requestvalue along with an indication of a reason for the adjustment, and theoverall value.

A technical effect of some embodiments of the invention is an improvedand computerized method to facilitate a dynamic, accurate, andtransparent adjustment of request values at a back-end applicationserver. With these and other advantages and features that will becomehereinafter apparent, a more complete understanding of the nature of theinvention can be obtained by referring to the following detaileddescription and to the drawings appended hereto.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is block diagram of a system according to some embodiments of thepresent invention.

FIG. 2 is a flow diagram of a process according to some embodiments.

FIG. 3 is block diagram of a back-end application computer server toolor platform according to some embodiments of the present invention.

FIG. 4 is a tabular portion of a rules database according to someembodiments.

FIG. 5 is a tabular portion of a data stream database according to someembodiments.

FIG. 6 is an example of a transaction activity report user interfaceassociated with a first example in accordance with some embodiments.

FIG. 7 is block diagram of a system associated with an insuranceenterprise according to some embodiments of the present invention.

FIG. 8 is a flow diagram of a process associated with an insuranceenterprise in accordance with some embodiments.

FIG. 9 is an example of a transaction activity report user interfaceassociated with insurance in accordance with some embodiments.

FIG. 10 is an example of an excess calculation report user interfaceassociated with insurance in accordance with some embodiments.

FIG. 11 is an example of notification message display according to someembodiments.

FIG. 12 illustrates a handheld tablet welcome message display accordingto some embodiments described herein.

DETAILED DESCRIPTION

The present invention provides significant technical improvements tofacilitate dynamic data processing. The present invention is directed tomore than merely a computer implementation of a routine or conventionalactivity previously known in the industry as it significantly advancesthe technical efficiency, access and/or accuracy of data created devicesdescribed in connection with some embodiments by implementing a specificnew method and system as defined herein. The present invention is aspecific advancement in the areas of back-end application computerservers by providing technical benefits in data accuracy, dataavailability, data transparency, and data integrity and such advancesare not merely a longstanding commercial practice. The present inventionprovides improvement beyond a mere generic computer implementation as itinvolves the processing and conversion of significant amounts of data ina new beneficial manner as well as the interaction of a variety ofspecialized back-end, client, and/or third-party systems, networks, andsubsystems. For example, in the present invention information may betransmitted from a remote third-party administrator server to a back-endapplication computer server and that information, including requestvalues, may be adjusted as appropriate in an accurate and transparentmanner.

Some embodiments described herein may facilitate a dynamic, accurate,and transparent adjustment of request values at a back-end applicationserver. Further, some embodiments may provide a mechanism that automatesa user interface that might be used, for example, by operators and/oradministrators of a third-party administrator computer server and/or aback-end application computer server. FIG. 1 is block diagram of asystem 100 according to some embodiments of the present invention. Inparticular, the system 100 includes a back-end application computerserver 150 that receives information from a third-party administratorcomputer server 110, stores that information in a data stream computerstore or database 152, and also exchanges information with a rulesdatabase 154 (e.g., which may store information such that different datastreams might be associated with different rules, thresholds,preferences, etc.).

The back-end application computer server 150 might be, for example,associated with a Personal Computers (PC), a spreadsheet applicationsuch as the EXCEL® spreadsheet application available from MICROSOFTCORPORATION® (e.g., including spreadsheet workbooks and/or templates), alaptop computer, an enterprise server, a server farm, and/or a databaseor similar storage devices. The back-end application computer server 150may, according to some embodiments, further includes rules engine and/orrendering component as described herein.

According to some embodiments, an “automated” back-end applicationcomputer server 150 may help promote accurate and transparentadjustments to values received from the third-party administratorcomputer server 110. For example, the back-end application computerserver 150 may automatically output an adjusted value via a GraphicalUser Interface (“GUI”) display along with an explanation of why thevalue was adjusted. Such a display might be provided, for example, via athird-party administrator remote computer device 120. As used herein,the terms “automated” and “automatically” may refer to, for example,actions that can be performed with little (or no) intervention by ahuman. Moreover, a present value calculation platform may “dynamically”receive a data stream of electronic messages (including values) and/orgenerate a portal output in substantially real time.

As used herein, devices, including those associated with the back-endapplication computer server 150 and any other device described herein,may exchange information via any communication network which may be oneor more of a Local Area Network (“LAN”), a Metropolitan Area Network(“MAN”), a Wide Area Network (“WAN”), a proprietary network, a PublicSwitched Telephone Network (“PSTN”), a Wireless Application Protocol(“WAP”) network, a Bluetooth network, a wireless LAN network, and/or anInternet Protocol (“IP”) network such as the Internet, an intranet, oran extranet. Note that any devices described herein may communicate viaone or more such communication networks.

The back-end application computer server 150 may store information intoand/or retrieve information from the databases 152, 154. The databases152, 154 might be associated with, for example, a back-end application.The databases 152, 152 might be locally stored or reside remote from theback-end application computer server 150. According to some embodiments,the back-end application computer server 150 communicates informationabout an adjusted value, such as by transmitting an electronic file orsignal to an electronic transaction system 160, an electronic messagingcommunication server 170, and/or an external platform 180 (e.g., aworkflow management system, calendar application, etc.).

Note that the back-end application computer server 150 might communicatewith the third-party administrator computer server 110 via a firstcommunication port 156 and with the third-party administrator remotecomputer device 120 via a second communication port 158. Further notethat these ports 156, 158 might comprise a single device, might provideelectronic security measures for a distributed communication network(e.g., a firewall), and/or might provide load balancing services (e.g.,arranging for multiple processors and/or programming instances toprocess information simultaneously) according to some embodiments.

Although a single back-end application computer server 150 is shown inFIG. 1, any number of such devices may be included. Moreover, variousdevices described herein might be combined according to embodiments ofthe present invention. For example, in some embodiments, the back-endapplication computer server 150 and databases 152, 154 might beco-located and/or may comprise a single apparatus.

FIG. 2 illustrates a method that might be performed, for example, bysome or all of the elements of the system 100 described with respect toFIG. 1 according to some embodiments. The flow charts described hereindo not imply a fixed order to the steps, and embodiments of the presentinvention may be practiced in any order that is practicable. Note thatany of the methods described herein may be performed by hardware,software, or any combination of these approaches. For example, acomputer-readable storage medium may store thereon instructions thatwhen executed by a machine result in performance according to any of theembodiments described herein.

At S210, a communication port may receive a plurality of data streams ofelectronic messages, each data stream being received from one of aplurality of remote third-party administrator computer servers via adistributed communication network (e.g., the Internet). According tosome embodiments, the communication port is associated with a back-endapplication computer server. Note that in some embodiments, the back-endapplication computer server processes multiple data streams from thefirst third-party administrator computer server, each data stream beingassociated with a different client (e.g., an employer or trade union)and different set of pre-determined rules for that client. At S220, thesystem may store information received in the data streams of electronicmessages into a data stream computer store.

At S230, the system may access a rules computer store storing differentsets of pre-determined rules for different third-party administratorcomputer servers.

At S240, a back-end application computer server may receive, from thedata stream computer store, information associated with a set ofrequests from a first third-party administrator computer server, eachrequest being associated with a request value.

At S250, the back-end application computer server may retrieve, from therules computer store, a first set of pre-determined rules for the firstthird-party administrator computer server. The first set ofpre-determined rules might include, for example, an aggregate requestvalue amount (e.g., accumulated values above or below certain thresholdsmight be automatically adjusted) and/or a rule based on a geographiclocation associated with a request (e.g., a request associated with afirst location might be treated differently as compared to a requestassociated with another location). As other examples, requests receivedbefore (or after) a certain date might be automatically adjusted and/theadjustments made to values could be absolute (e.g., the value is set tozero or some maximum amount), a percentage of the value, etc.

At S260, the back-end application computer server may automaticallyapply the first set of pre-determined rules to the set of requests fromthe first third-party administrator computer server. This application ofthe rules may result in at least one adjusted request value for the setof requests and an overall value based at least in part on the requestvalues and the adjusted request value associated with the set ofrequests. The automatic application of the first set of pre-determinedrules by the back-end application server may be performed, according tosome embodiments, on a periodic basis, such as a monthly basis, abi-weekly basis, or a weekly basis.

At S270, the back-end application computer server may automaticallytransmit a settlement instruction, including the overall value, to anelectronic transaction system. According to some embodiments, theelectronic transaction system receives the settlement instruction and,as a result executes a settlement transaction in accordance with theoverall value.

At S280, the back-end application computer server may render atransaction activity report display via a remote computer device,associated with the first third-party administrator computer server,including information about the set of requests, the at least oneadjusted request value along with an indication of a reason for theadjustment, and the overall value. According to some embodiments, thetransaction activity report display is rendered via a spreadsheetapplication, such as the EXCEL® spreadsheet application available fromMICROSOFT CORPORATION®. Note that in some embodiments, the transactionactivity report display can be customized, by a user at the remotecomputer device, to cover a time period from a start date to an end datefor the report.

According to some embodiments, application of the first set ofpre-determined rules may trigger an automatic transmission of a flag toan electronic messaging communication server. The electronic messagingcommunication server may receive the flag, and as a result of receivingthe flag, trigger an electronic notification from the electronicmessaging communication server to the remote computer device associatedwith the first third-party administrator computer server (e.g., to alertsomeone that values have been adjusted and/or explain why the valueswere adjusted).

The embodiments described herein may be implemented using any number ofdifferent hardware configurations. For example, FIG. 3 illustrates aback-end application tool or platform 300 that may be, for example,associated with the system 100 of FIG. 1. The back-end application toolor platform 300 comprises a processor 310, such as one or morecommercially available Central Processing Units (CPUs) in the form ofone-chip microprocessors, coupled to a communication device 320configured to communicate via a communication network (not shown in FIG.3). The communication device 320 may be used to communicate, forexample, with databases and/or to exchange information with remotethird-party administrator computer servers and/or computer devices. Theback-end application tool or platform 300 further includes an inputdevice 340 (e.g., a mouse, a keyboard, a touch screen, or a microphoneto receive information about rules and/or business logic) and an outputdevice 350 (e.g., to output reports and/or results of operation of theplatform 300). Note that the back-end application tool or platform 300might be associated with a back-end application executing remotely froma third-party administrator computer server.

The processor 310 also communicates with a storage device 330. Thestorage device 330 may comprise any appropriate information storagedevice, including combinations of magnetic storage devices (e.g., a harddisk drive), optical storage devices, mobile telephones, and/orsemiconductor memory devices. The storage device 330 stores a program312 and/or a rules engine 314 for controlling the processor 310. Theprocessor 310 performs instructions of the programs 312, 314, andthereby operates in accordance with any of the embodiments describedherein. For example, the processor 310 may receive data streams fromremote third-party administrator computer servers. In particular, theprocessor 310 may receive a set of requests from a first third-partyadministrator computer server, each request being associated with arequest value. The processor 310 may retrieve a first set ofpre-determined rules and automatically apply them to the set ofrequests, resulting in an adjusted request value and an overall value.The processor 310 may then automatically transmit a settlementinstruction, including the overall value, to an electronic transactionsystem, and render a transaction activity report display via a remotecomputer device, associated with the first third-party administratorcomputer server, including information about the set of requests, theadjusted request value along with an indication of a reason for theadjustment, and the overall value.

The programs 312, 314 may be stored in a compressed, uncompiled and/orencrypted format. The programs 312, 314 may furthermore include otherprogram elements, such as an operating system, a database managementsystem, and/or device drivers used by the processor 310 to interfacewith peripheral devices.

As used herein, information may be “received” by or “transmitted” to,for example: (i) the back-end application tool or platform 300 fromanother device; or (ii) a software application or module within theback-end application tool or platform 300 from another softwareapplication, module, or any other source.

In some embodiments (such as shown in FIG. 3), the storage device 330further stores a rules database 400 (e.g., containing different rulesfor various third-party administrator platforms) and a data streamdatabase 500 (e.g., to store inputs as they are received). Examples ofdatabases that may be used in connection with the back-end applicationtool or platform 300 will now be described in detail with respect toFIGS. 4 and 5. Note that the databases described herein are onlyexamples, and additional and/or different information may be storedtherein. Moreover, various databases might be split or combined inaccordance with any of the embodiments described herein. For example,the rules database 400 and/or data stream database 500 might be combinedand/or linked to each other within the rules engine 314.

Referring to FIG. 4, a table is shown that represents a rules database400 that may be stored at the back-end application tool or platform 300according to some embodiments. The table may include, for example,entries that may be associated with different data streams. The tablemay also define fields 402, 403, 404, 406 for each of the entries. Thefields 402, 403, 404, 406 may, according to some embodiments, specify:an identifier 402, a sub-identifier 403, a first rule 404, and a secondrule 406. The rules database 400 may be created and updated, forexample, as information is received when new third-party administratorplatforms are added to, or removed from, the system.

The third-party administrator identifier 402 and sub-identifier 403 maybe, for example, a unique alphanumeric code identifying a particularthird-party administrator platform and/or a specific client or datastream associated with that third-party administrator platform. Therules 404, 406 may define how request values received in a particulardata stream are to be reviewed and or adjusted. Although two rules 404,406 are defined in the rules database 400, note that any number of rulesand/or types of business logic may be supported.

By way of example, the first rule 404 for identifier (sub-identifier)“101(1)” indicates that request values should not be passed through(e.g., to another system such as an electronic transaction system) untila total of 1,000 has been accumulated. Moreover, the second rule 406indicates that accumulated values over 10,000 should never be passedthrough. Note that the values described in the rules 404, 406 might beassociated with any physical characteristic, electronic measurement orrepresentation, etc.

Referring to FIG. 5, a table is shown that represents a data streamdatabase 500 that may be stored at the back-end application tool orplatform 300 according to some embodiments. The table may include, forexample, entries associated with requests received in different datastreams by the back-end application tool or platform 300. The table mayalso define fields 502, 504, 506, 508, 510 for each of the entries. Thefields 502, 504, 506, 508, 510 may, according to some embodiments,specify: an identifier (sub-identifier) 502, a request identifier 504, arequest date and time 506, a request value 508, and a request type 510.The data stream database 500 may be created and updated, for example, asinformation is received from various third-party administrator computerservers.

The identifier (sub-identifier) 502 may be, for example, a uniquealphanumeric code identifying a particular third-party administratoridentifier platform/data stream and may be based on or associated withthe identifier 402 and sub-identifier 403 in the rules database 400. Therequest identifier 504 may be, for example, a unique alphanumeric codeidentifying a particular request received from a third-partyadministrator identifier platform and the date and time 506 may indicatewhen that request was received. The request value 508 may an amountincluded within the request and may be associated with any physicalcharacteristic, electronic measurement or representation, etc. Therequest type 510 may place the request into one or more categories thatcould be associated with, for example, a location, an entity, a type ofvalue, etc.

FIG. 6 is an example of a transaction activity report user interfacedisplay 600 associated with a first example in accordance with someembodiments. In particular, the display 600 illustrates how the eightrequested illustrated in FIG. 5 (R_101 through R_108) are processed bythe back-end application server based on the first rule 404 and thesecond rule 406 for the identifier 402 “101” and sub-identifier 403 “1”as illustrated in FIG. 4. Starting with the first two requests (R_101and R_102), the request values of 500 are reduced to zero because theaccumulated values have not accumulated to 1,000 (as required by thefirst rule 404), and that reason is indicated on the display 600. Thevalues associated with R_103 through R_106 are not adjusted at all (andno reason needs to be given on the display 600). The next request R_107is adjusted from 5,000 to 3,000 because 2,000 of the value is above anaccumulated amount of 10,000 (as required by the second rule 406), andthat reason is given on the display 600. The last request R_108 requestvalue is reduced to zero because the entire value is above the 10,000threshold (and that reason is provided on the display 600). In this way,a user of the display 600 can receive a “transparent” view of theinformation (e.g., he or she can easily understand why various requestvalues were adjusted).

Embodiments described herein, may be associated with a number ofdifferent back-end environments. In some cases, an insurer and aninsured are associated with a party who is potentially entitled toreceive a benefit. For example, an insured may purchase a workers'compensation insurance policy from an insurer, and both the insured andinsurer may have obligations with respect to benefits that must beprovided to a worker (who was injured while he or she was working).Depending on the terms and conditions of the particular insurancepolicy, the insured may be responsible for some payments while theinsurer is responsible for other payments. For example, an employermight be responsible for payments to employees up to a deductible amountand the insurer might be responsible for payments over the deductibleamount. Note that a third-party administrator may interact with andprovide payments to employees and then arrange for the employer orinsurer to reimburse those payments as appropriate. In other cases,escrow accounts may be established, an overall payment cap above whichan insurer will not provide certain types of payments may be provided,etc.

FIG. 7 is block diagram of a system 700 associated with an insuranceenterprise according to some embodiments of the present invention. Asbefore, the system 700 includes an insurance enterprise computer server750 that receives information from a third-party administrator computerserver 710, stores that information in a claim data flow database ordatabase 752, and also exchanges information with an insurance policydatabase 754 (e.g., which may store information such that differentthird-party administrator computer servers might be associated withdifferent deductibles, exceptions, preferences, etc.).

The insurance enterprise computer server 750 might be, for example,associated with a PC, a spreadsheet application such as the EXCEL®spreadsheet application available from MICROSOFT CORPORATION® (e.g.,including spreadsheet workbooks and/or templates), a laptop computer, anenterprise server, a server farm, and/or a database or similar storagedevices. The insurance enterprise computer server 750 may, according tosome embodiments, further includes rules engine and/or renderingcomponent as described herein.

According to some embodiments, an “automated” insurance enterprisecomputer server 750 may help promote accurate and transparentadjustments to insurance claim values received from the third-partyadministrator computer server 710. For example, the insurance enterprisecomputer server 750 may automatically output an adjusted insurance claimvalue via a GUI display along with an explanation of why the value wasadjusted. Such a display might be provided, for example, via athird-party administrator remote computer device 720 (e.g., associatedwith a web portal, smartphone, etc.).

As used herein, devices, including those associated with the insuranceenterprise computer server 750 and any other device described herein,may exchange information via any communication network which may be oneor more of a LAN, a MAN, a WAN, a proprietary network, a PSTN, a WAPnetwork, a Bluetooth network, a wireless LAN network, and/or an IPnetwork such as the Internet, an intranet, or an extranet. Note that anydevices described herein may communicate via one or more suchcommunication networks.

The insurance enterprise computer server 750 may store information intoand/or retrieve information from the databases 752, 754. The databases752, 754 might be associated with, for example, a back-end application.The databases 752, 752 might be locally stored or reside remote from theinsurance enterprise computer server 750. According to some embodiments,the insurance enterprise computer server 750 communicates informationabout an adjusted insurance claim value, such as by transmitting anelectronic file or signal to a banking system 760 (which may include aledger processing system 762) to facilitate an Automated Clearinghouse(“ACH”) payment via a bank associated with the third-partyadministrator, an email communication server 770 (e.g., to sendautomatically created alert emails to the third-party administrator whenan insurance claim value is adjusted, and/or an external platform 780(e.g., a workflow management system, calendar application, etc.).

Note that the insurance enterprise computer server 750 might communicatewith the third-party administrator computer server 710 via a firstcommunication port 756 and with the third-party administrator remotecomputer device 720 via a second communication port 758. Further notethat these ports 756, 758 might comprise a single device, might provideelectronic security measures for a distributed communication network(e.g., a firewall), and/or might provide load balancing services (e.g.,arranging for multiple processors and/or programming instances toprocess information simultaneously) according to some embodiments.

Although a single insurance enterprise computer server 750 is shown inFIG. 7, any number of such devices may be included. Moreover, variousdevices described herein might be combined according to embodiments ofthe present invention. For example, in some embodiments, the insuranceenterprise computer server 750 and databases 752, 754 might beco-located and/or may comprise a single apparatus.

FIG. 8 illustrates a method that might be performed, for example, bysome or all of the elements of the system 700 described with respect toFIG. 7 according to some embodiments. At S810, a plurality of datastreams may be received, each data stream being received from one of aplurality of remote third-party administrator computer servers via theInternet. According to some embodiments, the communication port isassociated with an insurance enterprise computer server. Note that insome embodiments, the insurance enterprise computer server processesmultiple data streams from a first third-party administrator, each datastream being associated with a different client (e.g., an employer ortrade union) and a particular deductible amount and exception rule forthat client. Further note that in some embodiments a single client couldhave two or more associated data streams each associated with differenttypes of insurance coverages. For example, to single client may haveboth workers' compensation insurance and group benefits insurance, eachhaving different rules, deductibles, exceptions, etc. At S820, thesystem may store information received in the data streams into aninsurance claim data stream database. At S830, the system may access aninsurance database storing different deductible amounts and exceptionrules for different third-party administrator computer servers.

At S840, an insurance enterprise computer server may receive, from theinsurance claim data stream database, information associated with a setof insurance claims from a first third-party administrator, eachinsurance claim being associated with an insurance claim value.

At S850, the insurance enterprise may retrieve, from the insurancepolicy, a first deductible amount and exception rule for the firstthird-party administrator. The first deductible amount and exceptionrule might include, for example, an aggregate insurance claim valueamount (e.g., accumulated values (accumulated over an insurance policyperiod or a current month) above or below certain dollar thresholdsmight be automatically adjusted) and/or a rule based on a geographiclocation associated with a request (e.g., a request associated with afirst state might be treated differently as compared to a requestassociated with another state). As other examples, requests receivedbefore (or after) a certain policy dates might be automatically adjustedand/ the adjustments made to values could be absolute (e.g., the valueis set to zero or some maximum amount), a percentage of the value may beprorated between an insurer and an employer, etc.

At S860, the insurance enterprise may automatically apply the firstdeductible amount and exception rule to the set of insurance claims fromthe first third-party administrator. This application may result in atleast one adjusted insurance claim value for the set of claims and anoverall settlement value based at least in part on the insurance claimvalues and the adjusted insurance claim value. The automatic applicationmay be performed, according to some embodiments, on a periodic basis,such as a monthly basis, a bi-weekly basis, or a weekly basis.

At S870, the insurance enterprise may automatically transmit an ACHsettlement instruction, including the overall value, to a bankingsystem. According to some embodiments, the banking system receives thesettlement instruction and, as a result executes a settlement paymenttransaction to a bank in accordance with the overall settlement value.

At S880, the insurance enterprise computer server may display atransaction activity report display via a remote computer device,associated with the first third-party administrator, includinginformation about the set of insurance claims, the at least one adjustedinsurance claim value along with an indication of a reason for theadjustment, and the overall settlement value. According to someembodiments, the transaction activity report display is rendered via aspreadsheet application, such as the EXCEL® spreadsheet applicationavailable from MICROSOFT CORPORATION® and/or a web portal interface.Note that in some embodiments, the transaction activity report displaycan be customized, by a user at the remote computer device, to cover atime period from a start date to an end date for the report. Accordingto some embodiments, a transaction activity spreadsheet report mayfurther include a display of: a current month payable amount, a currentpolicy period payment amount, a date associated with a claim, and ageographic location exception indication.

According to some embodiments, application of the first deductibleamount or exception rules may trigger an automatically transmission of aflag to an email server. The email server may receive the flag, and as aresult of receiving the flag, trigger an email notification from theemail server to the remote computer device associated with the firstthird-party administrator computer server (e.g., to alert someone thatinsurance claim values have been adjusted and/or explain why the valueswere adjusted).

According to some embodiments, the method 800 of FIG. 8 may beassociated with a medical insurance policy and/or a workers'compensation insurance policy. Moreover, the deductible amount might beassociated with at least one of: (i) a standard deductible amount, (ii)a loss limit, (iii) a retention amount, (iv) a cap amount, (v) a stepamount, (vi) an escrow account, (vii) an insurance basket, (viii) acorridor deductible, (ix) a crash deductible, and/or (x) a dateassociated with an insurance claim. The exception rule may be associatedwith, for example, at least one of: (i) a type of insurance claim, (ii)a geographic location associated with an insurance claim, and/or (iii) aspecific provision of an insurance policy.

According to some embodiments, an insurance enterprise server isconfigured to generate at least one of: (i) a reconciliation message,and (ii) an excess calculation report. For example, an excesscalculation report includes at least one of: (i) an exceptionidentifier, (ii) an exception state, and (iii) an exception amount. Forexample, the insurance enterprise might need to pay 100% of medicalexpenses if the insurance claim originated from California (but not ifthe claim originated in Texas). A transaction activity spreadsheetreport might include, according to some embodiments, at least five of:(i) a claim level payable amount, (ii) a transactions total amount,(iii) a cumulative total paid, (iv) a claimant, (v) a claim number, (vi)an insurer claim number, (vii) a date of loss, (viii) a transactionamount, (ix) a payment description, (x) a draft or check number, (xi) adraft date, (xii) an account name, (xiii) a product name, (xix) aninsurance policy number, (xx) a deductible/loss limit/retention amount,(xxi) a policy inception date, (xxii) a policy expiration date, (xxiii)a third-party administrator identifier, (xxiv) a third-partyadministrator name, (xxv) an organization identifier, (xxvi) a valuationdate, (xxvii) a payable document number, (xxviii) a line of business,(xxix) an entry code, (xxx) a loss event branch, (xxxi) a loss eventidentifier, and (xxxii) a loss event claim counter.

FIG. 9 is an example of a transaction activity report user interfacedisplay 900 associated with insurance in accordance with someembodiments. The display 900 might provide information about insuranceclaims submitted (or resolved) during a particular time period. By wayof example, the display might include a claim level payable amount(e.g., an amount reimbursed for specific claim; a transactions totalamount (e.g., a total activity on a claim for a specified period, andnote that this period could be different than the claim level payableamount); a cumulative total paid (e.g., a total amount of funds paid atthe claim level; a claimant (e.g., a claimant name); a third-partyadministrator claim number (e.g., a third-party administrator claimnumber; an insurance enterprise claim number (e.g., a claim numberassigned by the insurance enterprise); a date of loss; a transactionamount (e.g., a transaction level detail); payment description;third-party administrator draft or check number; a third-partyadministrator draft date (e.g., a transaction date); an account name; apricing plan (e.g., a type of coverage, such as guaranteed cost,deductible, prefunded deductible, conventional retro, and/or paid lossretro); a product name line of business (e.g., a workers' compensation,general liability); a policy number (e.g., an insurance enterprisepolicy number); deductible/loss limit/retention values; a policyinception date; a policy expiration date; a third-party administratorname; a valuation date (e.g., which might include all data received andprocessed by the insurance enterprise from the first of the month to thevaluation date, such as the last day of the month); and/or a Line OfBusiness (“LOB”).

FIG. 10 is an example of an excess calculation report user interfacedisplay 1000 associated with insurance in accordance with someembodiments. The display 1000 might include, for example: a third-partyadministrator name; a third-party administrator account number or name;a program effective date; a program expiration date; an insurance policynumber; a policy effective date; a policy expiration date; a product;included products; a pricing plan; retention limits; claim/occurrencelimits; application; prop ale (y/n); a basket/policy aggregate amount; astep limits-definition a step claim a step amount; acorridor-definition; a corridor; a corridor amount; a clash; a clashclaim; a clash amount; an exception definition; an exceptions (type);exceptions (state, etc.); and a limit amount. The display 1000 mightfurther include, for example: a state; a third-party administrator claimnumber; key claim number; claim; a loss limit; an adjustment type (absor adj); a loss limit adjustment amount; a limit; a prior ind paid;prior med paid; prior exp paid; total prior; current ind paid; currentmed paid; current exp paid; a total current; and a claim level payable

FIG. 11 is an example of notification message display 1100 according tosome embodiments. The notification message display 1100 might include,for example, an account number, an account name, a third-partyadministrator name, a document number, a payable amount, a cash callamount, a cash call date, and/or comments (e.g., associated withadjustments made to insurance claim amounts).

Thus, embodiments may provide systems and methods to facilitate adynamic, accurate, and transparent adjustment of request values for aback-end application. According to some embodiments, funding invoiceswill no longer be necessary for accounts subject to payables process.Moreover, in some embodiments, the automated funding schedule isflexible (weekly, bi-weekly or monthly) and can be based on athird-party administrator preference. Further, in some cases, funds maybe deposited into each third-party administrator's designated bankaccount(s) approximately seven (7) days after a production data feed. Insome embodiments, check register style payable documents reflectingfunding transactions for a third-party administrator may be available.

Although specific hardware and data configurations have been describedherein, note that any number of other configurations may be provided inaccordance with embodiments of the present invention (e.g., some of theinformation associated with the databases described herein may becombined or stored in external systems). Additionally, one or more ofthe elements described herein may be practiced in a distributed cloudcomputing environment where tasks are performed by logically orphysically remote processing devices that are linked through one or morecommunications networks. For example, FIG. 12 illustrates a handheldtablet 1200 welcome display according to some embodiments describedherein. In particular, the handheld tablet 1200 is displaying welcomemessage that might be transmitted to a new user or third-partyadministrator of any of the systems described herein.

The present invention has been described in terms of several embodimentssolely for the purpose of illustration. Persons skilled in the art willrecognize from this description that the invention is not limited to theembodiments described, but may be practiced with modifications andalterations limited only by the spirit and scope of the appended claims.

What is claimed is:
 1. A system to improve an accuracy of informationgenerated by a back-end application computer server, comprising: (a) acommunication port to facilitate receipt of a plurality of data streamsof electronic messages, each data stream being received from one of aplurality of remote third-party administrator computer servers via adistributed communication network; (b) a data stream computer store tostore information received in the data streams of electronic messages;(c) a rules computer store to store different sets of pre-determinedrules for different third-party administrator computer servers; (d) theback-end application computer server, coupled to the communication port,the data stream computer store, and the rules computer store, programmedto: (i) receive from the data stream computer store informationassociated with a set of requests from a first third-party administratorcomputer server, each request being associated with a request value,(ii) retrieve from the rules computer store a first set ofpre-determined rules for the first third-party administrator computerserver, (iii) automatically apply the first set of pre-determined rulesto the set of requests from the first third-party administrator computerserver, said application resulting in at least one adjusted requestvalue for the set of requests and an overall value based at least inpart on the request values and the adjusted request value associatedwith the set of requests, (iv) automatically transmit a settlementinstruction, including the overall value, to an electronic transactionsystem, and (v) as a result of application of the first set ofpre-determined rules, automatically transmit a flag to an electronicmessaging communication server; (e) the electronic transaction system toreceive the settlement instruction and to execute a settlementtransaction in accordance with the overall value; and (f) the electronicmessaging communication server to receive said flag, and as a result ofreceiving said flag, trigger an electronic notification from theelectronic messaging communication server to the remote computer deviceassociated with the first third-party administrator computer server. 2.The system of claim 1, wherein the communication port further providesat least one of: (i) security features for the distributed communicationnetwork, and (ii) load balancing functionality.
 3. The system of claim1, wherein the back-end application computer server is to processmultiple data streams from the first third-party administrator computerserver, each data stream being associated with a different client anddifferent set of pre-determined rules for that client.
 4. The system ofclaim 1, wherein said automatic application of the first set ofpre-determined rules by the back-end application server is performed ona periodic basis associated with at one of: (i) a monthly basis, (ii) abi-weekly basis, or (iii) a weekly basis.
 5. The system of claim 1,wherein the first set of pre-determined rules includes at least one of:(i) an aggregate request value amount, and (ii) a rule based on ageographic location associated with a request.
 6. The system of claim 1,wherein a transaction activity report display is rendered via aspreadsheet application.
 7. The system of claim 1, wherein a transactionactivity report display can be customized, by a user at the remotecomputer device, to cover a time period from a start date to an end datefor the report.
 8. A computerized method to improve an accuracy ofinformation generated by a back-end application computer server,comprising: receiving at a communication port a plurality of datastreams of electronic messages, each data stream being received from oneof a plurality of remote third-party administrator computer servers viaa distributed communication network; storing information received in thedata streams of electronic messages into a data stream computer store;accessing a rules computer store storing different sets ofpre-determined rules for different third-party administrator computerservers; receiving, by a back-end application computer server from thedata stream computer store, information associated with a set ofrequests from a first third-party administrator computer server, eachrequest being associated with a request value; retrieving, by theback-end application computer server from the rules computer store, afirst set of pre-determined rules for the first third-partyadministrator computer server; automatically applying, by the back-endapplication computer server, the first set of pre-determined rules tothe set of requests from the first third-party administrator computerserver, said application resulting in at least one adjusted requestvalue for the set of requests and an overall value based at least inpart on the request values and the adjusted request value associatedwith the set of requests; as a result of applying the first set ofpre-determined rules, automatically transmitting, by the back-endapplication computer server, a flag to an electronic messagingcommunication server; automatically transmitting, by the back-endapplication computer server, a settlement instruction, including theoverall value, to an electronic transaction system; receiving, by theelectronic transaction system, the settlement instruction and executinga settlement transaction in accordance with the overall value; andreceiving, by the electronic messaging communication server, said flagand as a result of receiving said flag, triggering an electronicnotification from the electronic messaging communication server to theremote computer device associated with the first third-partyadministrator computer server.
 9. The method of claim 8, furthercomprising: providing security features for the distributedcommunication network; and providing load balancing functionality. 10.The method of claim 9, wherein the back-end application computer serveris to process multiple data streams from the first third-partyadministrator computer server, each data stream being associated with adifferent client and different set of pre-determined rules for thatclient.
 11. The method of claim 8, wherein said automatic application ofthe first set of pre-determined rules by the back-end application serveris performed on a periodic basis associated with at one of: (i) amonthly basis, (ii) a bi-weekly basis, or (iii) a weekly basis.
 12. Themethod of claim 8, wherein the first set of pre-determined rulesincludes at least one of: (i) an aggregate request value amount, and(ii) a rule based on a geographic location associated with a request.13. A system to improve an accuracy of information generated by aninsurance enterprise computer server, comprising: (a) a communicationport to receive a plurality of insurance claim data streams, eachinsurance claim data stream being received from one of a plurality ofremote third-party administrator devices via the Internet; (b) aninsurance claim data stream database to store information received inthe insurance claim data streams; (c) an insurance policy database tostore different sets of pre-determined deductible amounts and exceptionrules for different third-party administrators; (d) the insuranceenterprise server, coupled to the communication port, the insuranceclaim data stream database, and the insurance policy database,programmed to: (i) receive from the insurance claim data stream databaseinformation associated with a set of claims from a first third-partyadministrator, each claim being associated with a claim value, (ii)retrieve from the insurance policy database a first pre-determineddeductible amount and exception rule for the first third-partyadministrator, (iii) automatically apply the first pre-determineddeductible amount and exception rule to the set of claims from the firstthird-party administrator, said application resulting in at least oneadjusted claim value for the set of claims and an overall settlementvalue based at least in part on the claim values and the adjusted claimvalue associated with the set of claims, (iv) automatically transmit anautomated clearinghouse payment instruction, including the overallsettlement value, to an electronic banking system, and (v) as a resultof application of the first pre-determined deductible amount andexception rule, automatically transmit a flag to an electronic messingcommunication server; (e) the electronic banking system to receive theautomated clearinghouse payment instruction and to execute a settlementin accordance with the overall settlement value; and (f) the electronicmessaging communication server to receive said flag, and as a result ofreceiving said flag, trigger an electronic notification from theelectronic messaging communication server to the remote computer deviceassociated with the first third-party administrator device.
 14. Thesystem of claim 13, wherein the insurance policy is associated with atleast one of: (i) a medical insurance policy, and (ii) a workers'compensation insurance policy.
 15. The system of claim 13, wherein thedeductible amount is associated with at least one of: (i) a standarddeductible amount, (ii) a loss limit, (iii) a retention amount, (iv) acap amount, (v) a step amount, (vi) an escrow account, (vii) aninsurance basket, (viii) a corridor deductible, (ix) a crash deductible,and (x) a date associated with an insurance claim.
 16. The system ofclaim 13, wherein the exception rule is associated with at least one of:(i) a type of insurance claim, (ii) a geographic location associatedwith an insurance claim, and (iii) a specific provision of an insurancepolicy.
 17. The system of claim 13, wherein the insurance enterpriseserver is further to generate at least one of: (i) a reconciliationmessage, and (ii) an excess calculation report.
 18. The system of claim17, wherein the excess calculation report includes at least one of: (i)an exception identifier, (ii) an exception state, and (iii) an exceptionamount.
 19. The system of claim 13, wherein a transaction activityspreadsheet report includes at least five of: (i) a claim level payableamount, (ii) a transactions total amount, (iii) a cumulative total paid,(iv) a claimant, (v) a claim number, (vi) an insurer claim number, (vii)a date of loss, (viii) a transaction amount, (ix) a payment description,(x) a draft or check number, (xi) a draft date, (xii) an account name,(xiii) a product name, (xix) an insurance policy number, (xx) adeductible/loss limit/retention amount, (xxi) a policy inception date,(xxii) a policy expiration date, (xxiii) a third-party administratoridentifier, (xxiv) a third-party administrator name, (xxv) anorganization identifier, (xxvi) a valuation date, (xxvii) a payabledocument number, (xxviii) a line of business, (xxix) an entry code,(xxx) a loss event branch, (xxxi) a loss event identifier, and (xxxii) aloss event claim counter.
 20. The system of claim 13, wherein: atransaction activity spreadsheet report further includes a display of:(i) a current month payable amount, (ii) a current policy period paymentamount, and (iii) a date associated with a claim; and an excesscalculation report includes a display of a geographic location exceptionindication.